Timothy P. Daaleman, DO, is a family physician researcher with expertise in examining the influence of religious and spiritual variables in healthcare settings. This application will provide a period of mentored training comprised of: a research practicum within the Center on Aging at the University of Kansas Medical Center (KUMC); coursework in the Masters in Public Health (MPH) program and at the University of Kansas in Lawrence; and a research project to test a theoretical model of the relationship between spirituality and patient conceptualization of death and dying in a population of community-dwelling elders with serious illness. The plan outlines the training and research experience he will require, in order to develop and launch a fully independent research career that will focus on understanding and improving the dying process and end-of-life care among elders in the United States. Career Development Plan: Course work from MPH program forms the core portion of the didactic training period and will be complimented by practical training in study design, subject recruitment, data collection and analysis, and project management within the KUMC Center on Aging. Research Program: The SUPPORT trial not only awakened American medicine to reexamine the way it cares for seriously ill and dying patients, but also has indirectly promoted a rapprochement among the realms of spirituality, religion, and the practice of medicine. An understanding of the psychological, social, cultural, and now spiritual elements and processes that are involved in the composition of death and dying attitudes holds promise in comprehending and potentially improving the difficult transition that older patients make from serious illness to dying. The overall objective of this research project is to describe and understand the determinants of elders attitudes toward serious illness, death, the dying process, and discussions of advance care planning. Both rural and urban primary care physicians (N=10) who have been members of the Kansas Hartford Geriatric Project, and older community-dwelling patients with serious illness from their practices (N=270), will participate in three phases of the study: a cross-sectional survey, a prospective, longitudinal cohort study, and qualitative semi-structured interviews. The primary aim is to determine the social, psychological, spiritual, and cultural influences that comprise attitudes towards death and the dying process in older persons. Our hypothesis is that patient spirituality is a significant explanatory factor in death attitudes after accounting for multiple covariates, i.e. social support, mental health status. Secondary aims include learning how a baseline measure of patient spirituality predicts future death attitudes and discussions of advance care planning.